ABSTRACT
Objective To investigate a reasonable and effective internal fixation method for posterolateral fracture of the tibial plateau. Methods Specimens of the tibial plateau with posterolateral fracture made from 12 adult male cadavers were randomly and evenly divided into 3 groups, and fixed by anterior 6.5 mm lag screw, lateral 4.5 mm L-shape plate, posterior 3.5 mm T-shape plate, respectively. All the specimens were loaded in turn by stress of 250, 500, 750, 1 000 N, and the corresponding axial displacement and stress were measured. Results Under the same stress, the Y-axial displacement of the anterior lag screw group was the smallest, showing a significant difference with the lateral plate group and the posterior plate group, while there was no significant difference between the lateral plate group and the posterior plate group in the Y-axial displacement. The stresses on marked points in the anterior lag screw group were evenly distributed. Conclusions For fixation of isolated posterolateral fractures of the tibial plateau, the anterior 6.5 mm lag screw can effectively increase the axial stability and balance the stress distribution around the fracture block, indicating it is an effective method for mechanical fixation. The lateral plate has certain advantage in lateral stability control, while the posterior plate has certain value to reduction of the posterior tibia plateau fracture.
ABSTRACT
Objective To investigate the differences in biomechanical properties of 3 internal fixation patterns(the lateral plate and screw group, the rear plate and screw group, and the front and rear lag screw group) for treating posterolateral tibial plateau fracture under different axial loads. Methods Based on CT data of the tibial plateau, the entity model of 1/2 and 1/4 posterolateral tibial plateau fracture with 3 internal fixations were established and meshed to analyze force status of the fracture models with 3 internal fixations under different axial loads. ResultsUnder the axial load of 1 kN, for the 1/2 posterolateral tibial plateau fracture model, the displacements of the fracture fragments in the lateral plate and screw group, the rear plate and screw group, and the front and rear lag screw were 552.082, 67.964, 54.085 μm, respectively, and the stresses on the fixation device were 306.745, 231.844, 73.047 MPa, respectively. For the 1/4 posterolateral tibial plateau fracture model, the displacements in the three groups above were 416.072, 302.107, 150.639 μm, respectively, and the stresses on the fixation device were 306.673, 208.467, 73.607 MPa, respectively. Both the displacements of the fracture fragments and the stresses on the fixation device increased correspondingly under the axial load of 1.5 kN, and the trend of the data was similar to that under the axial load of 1 kN. Conclusions The results from the fracture models with 3 internal fixation patterns show that the front and rear lag screw group has a superior biomechanical stability under two different axial loads, and the similar mechanical properties can be achieved in the rear plate and screw group. Therefore, the front and rear lag screws will be preferred to treat posterolateral tibial plateau fracture with less obvious displacement in clinic.
ABSTRACT
<p><b>OBJECTIVE</b>To discuss the curative effect of traditional treatment and combination therapy for senile hip fracture.</p><p><b>METHODS</b>Using prospective methods to choose 300 cases of elderly patients with hip fractures from February 2011 to December 2012, which were randomly divided into comprehensive treatment group and conventional treatment group. After screening, 148 case were in comprehensive treatment group,including 62 males and 86 females with an average age of (78.76 +/- 7.32) years old ranging from 60 to 88; 45 cases were intertrochanteric fracture of femur, 103 cases were fracture of neck of femur; Singh index > or = IV in 74 cases, < IV in 74 cases;preoperative Harris score was 39.90 +/- 2.28. There were 146 cases in conventional treatment group,including 60 males and 86 females with an average age of (80.00 +/- 7.06) years old ranging from 66 to 96; 50 cases were intertrochanteric fracture of femur, 96 cases were fracture of neck of femur; Singh index > or = IV in 75 cases, < IV in 71 cases; preoperative Harris score was 40.10 +/- 2.81. Preoperative general situation,leaving bed time and hospital stay, the incidence of postoperative 12 weeks Singh index > or = IV and DPD/Cr value, Harris score at 12 months after operation and the incidence of fracture again of two groups were observed and compared.</p><p><b>RESULTS</b>In comprehensive treatment group 140 patients were followed up for 12 to 18 months with an anverage of 14.80 +/- 1.85. In conventional treatment group 132 patients were followed up for 12 to 14 months with an average of 12.75 +/- 0.79. There were no significant differences in age, gender, the classification of fracture, preoperative Harris hip score, preoperative Singh index > or = IV level and DPD/Cr value between the two groups (P > 0.05). Comprehensive treatment group had shorter leaving bed time and hospital stay, smaller postoperative 12 weeks DPD/Cr value and higher postoperative Harris score, higher incidence of postoperative 12 weeks Singh index > or = IV level, lower incidence of fracture again than conventional treatment group, there was statistically significant difference between two groups (P < 0.05).</p><p><b>CONCLUSION</b>For the anti-osteoporosis effect, the comprehensive treatment group has more advantage than traditional treatment group in elderly hip fracture, which can further improve the elderly hip fracture treatment and provide the reference of evidence-based medicine cooperate with rehabilitation department.</p>